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Category: Business Services
Facility: IHA Administration
Department: Business Services
Schedule: Full Time
Hours: 40 Hours
Job Details: 1 - 3 years of experience required


The Claims Processor is responsible for examining claims submitted by healthcare providers for accuracy and completeness before submitting to insurance companies. 




1.       Processes regular and complex claims for all payers, including Coordination of Benefits and claim adjustments.

2.       Enters Fastnotes into the practice management system (PMS).

3.       Follows guidelines for Coordination of Benefits/Medicare coordination.

4.       Interacts with other departments as required to resolve complex claims.

5.       Refers claims that have dropped in error for review and correction to accounts receivable representatives.

6.       Obtains appropriate paperwork from practices for workers' compensation and auto accident claims

7.       Prepares Medicaid secondary claims prepared on Claims Management System (CMS) within Medicaid requirements.

8.       Corrects charges entered in computer incorrectly.

9.       Retrieves Explanation of Benefits (EOB) for secondary and tertiary claims. 

10.    Completes assigned tasks for payer's U277 reports.

11.    Responds to returned mail, incorrect address and incorrect claims.

12.    Provides support for EOB scanning.

13.    Files various reports and batches.

14.    All other duties as assigned

15.    Performs other duties as assigned.



1.      Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the IHA CARES mission and core values statement.

2.      Must be able to work effectively as a member of the Business Services team.

3.      Successfully completes IHA's "The Customer" training and adheres to IHA's standard of promptly providing a high level of service and respect to internal or external customers.

4.      Maintains knowledge of and complies with IHA standards, policies and procedures, including IHA's Employee Handbook.

5.      Maintains complete knowledge of office services and in the use of all relevant office equipment, computer, and manual systems.

6.      Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines

7.      Serves as a role model, by demonstrating exceptional ability and willingness to take on new and additional responsibilities.  Embraces new ideas and respects cultural differences.

8.      Uses resources efficiently.

9.      If applicable, responsible for ongoing professional development – maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.



Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.





EDUCATION:  High School Diploma

  2-3 years' prior medical claims submission and medical billing experience required.





1.      Knowledge of medical terminology and procedures at the level needed to perform responsibilities, including understanding of CPT and ICD9 coding.

2.      Knowledge of rules and regulations regarding insurance claim submission.

3.      Ability to investigate and resolve billing and coding problems.

4.      Sufficient knowledge of mathematics.

5.      Proficient in operating a standard desktop and Windows-based computer system, including but not limited to,  Outlook, Microsoft Word and Excel, intranet and computer navigation.  Ability to use other software as required while performing the essential functions of the job.

6.      Excellent communication skills in both written and verbal forms, including proper phone etiquette

7.      Ability to work collaboratively in a team-oriented environment; courteous and friendly demeanor.

8.      Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, providers, family members, insurance carriers, and vendors.

9.      Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.

10.   Good organizational and time management skills to effectively juggle multiple priorities and time constraints.

11.   Ability to exercise sound judgment and problem-solving skills, specifically as it relates to resolving billing and coding problems.

12.    Ability to handle patient and organizational information in a confidential manner.

13.   Successful completion of IHA competency-based program within introductory and training period.

14.   Sufficient knowledge of medical terminology to perform responsibilities.




1.      Physical activity that often requires keyboarding, filing and phone work.

2.      Physical activity that often requires extensive time working on a computer.

3.      Physical activity that sometimes requires walking, standing, bending, stooping, reaching, and/or twisting.       

4.      Physical activity that sometimes requires lifting, pushing and/or pulling under 30 lbs.

5.      Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus. 

6.      Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.

7.      Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.



This job operates in a typical office environment which involves frequent interruptions and significant interaction with people which can be stressful at times.



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